| 본문 : We report a case of a female patient with thyroid eye disease (TED) who presented with aggravated TED and anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis with psychotic features. A 27-year-old woman, who had been previously diagnosed with TED and treated with intravenous (IV) steroid therapy (total 8 g over approximately 7 months) at our clinic, was presented to us at the emergency department with progressing exophthalmos, exposure keratopathy, and psychotic features, including disorganized speech and irritable behavior. The patient had been receiving IV steroid therapy for aggravating TED at a different hospital; however, steroid therapy was discontinued based on the hypothesis that the patient might be undergoing steroid-induced psychosis. Upon arrival at our emergency department, the patient was admitted and underwent successful emergency orbital decompression. From postoperative day (POD) 3, the patient showed catatonia, tremor, and rigidity. She was referred to the neurology department and underwent evaluation for central nervous system (CNS) disorders. Brain MRI, cerebrospinal fluid (CSF) study, and electroencephalography (EEG) was negative for infectious, neoplastic, or vascular cause and the patient was started on IV methylprednisolone 1g for 5 days under the clinical impression of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. Patient’s laboratory test result was positive for anti-NMDAR antibody in both serum and CSF. After no significant improvement, the patient was treated with IV immunoglobulin and IV rituximab. During the course of treatment, the patient was able to obey commands, increase verbal output, and perform daily activities. Her regimen was replaced with oral mycophenolate mofetil and has been stable since her discharge. We report, for the first time, of a case in which a TED patient accompanied by anti-NMDAR encephalitis, also an autoimmune disease, was successfully treated with surgical and medical treatment. |